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 Articles

A person in a white coat holds a vial of blood drawn from a seated person in a brown sweater

Best Practices: The Do's and Do Not's of Blood Cultures

September 4, 2024

Dear colleagues,

Systemwide, ~3000 blood cultures are collected monthly at UTMB.  Approximately 10% of these blood cultures result in microbial growth and ~25-30% are contaminant.

Considering the recent shortage of blood culture media, and non-judicious use of blood cultures, health systems across the country are implementing guidance for judicious use of blood culture collection. Below are best practices:

THE DO’S AND DO NOT’S OF BLOOD CULTURE

1.    DO consider the indication for blood culture collection. Infectious syndromes with a high pre-test probability (>10%) of bloodstream involvement warrant blood culture collection for pathogen identification and antibiotic susceptibility. (Table 1)

2.      DO repeat blood cultures for select bacteremias. Repeating blood cultures is warranted for infective endocarditis, Candidemia, Staphylococcus aureus (MSSA and MRSA) and Staphylococcus lugdunensisbacteremias due to their refractory and metastatic nature. Repeat blood cultures are not indicated in clinically improving patients with most other organisms such as streptococcal or gram-negative bacteremia.

3.      DO reach out to the Infectious Diseases physician on service for guidance on questions or concerns arising from nursing staff or phlebotomy regarding appropriateness of blood cultures collection.

4.      DO escalate “difficult sticks” or patient-related challenges in obtaining cultures to the Charge Nurse or Nursing Educator.

5.      DO NOT automatically repeat blood cultures for coagulase negative Staphylococci (CONS) or other skin commensals. Contamination is suggested when bacterial growth occurs >48 hours after collection, is isolated to a single blood culture set, or if an alternative diagnosis is more likely.

6.      DO NOT obtain blood cultures for isolated fever, post-procedural fever or isolated leukocytosis. If a patient is hemodynamically stable and develops fever, it is reasonable to monitor and examine for localizing symptoms and signs and use a systematic approach to guide diagnosis and treatment. 

7.      DO NOT obtain blood cultures from indwelling intravenous (IV) catheters. Central venous catheters (CVCs), hemodialysis catheters, tunneled ports and IV catheters, peripherally inserted central catheters (PICCs), midlines, and peripheral IV catheters should not be accessed for blood culture collection given a high rate of luminal colonization.  

8.      DO NOT obtain blood cultures in ambulatory settings. Blood cultures are not indicated for patients with infectious syndromes being treated empirically unless these patients are being hospitalized or directed to the ED.
 
Thank you,
Antimicrobial Stewardship Team
Lab Stewardship Team
Infection Control & Healthcare Epidemiology
A person in a white coat holds a vial of blood drawn from a seated person in a brown sweater

Best Practices: The Do's and Do Not's of Blood Cultures

September 4, 2024

Dear colleagues,

Systemwide, ~3000 blood cultures are collected monthly at UTMB.  Approximately 10% of these blood cultures result in microbial growth and ~25-30% are contaminant.

Considering the recent shortage of blood culture media, and non-judicious use of blood cultures, health systems across the country are implementing guidance for judicious use of blood culture collection. Below are best practices:

THE DO’S AND DO NOT’S OF BLOOD CULTURE

1.    DO consider the indication for blood culture collection. Infectious syndromes with a high pre-test probability (>10%) of bloodstream involvement warrant blood culture collection for pathogen identification and antibiotic susceptibility. (Table 1)

2.      DO repeat blood cultures for select bacteremias. Repeating blood cultures is warranted for infective endocarditis, Candidemia, Staphylococcus aureus (MSSA and MRSA) and Staphylococcus lugdunensisbacteremias due to their refractory and metastatic nature. Repeat blood cultures are not indicated in clinically improving patients with most other organisms such as streptococcal or gram-negative bacteremia.

3.      DO reach out to the Infectious Diseases physician on service for guidance on questions or concerns arising from nursing staff or phlebotomy regarding appropriateness of blood cultures collection.

4.      DO escalate “difficult sticks” or patient-related challenges in obtaining cultures to the Charge Nurse or Nursing Educator.

5.      DO NOT automatically repeat blood cultures for coagulase negative Staphylococci (CONS) or other skin commensals. Contamination is suggested when bacterial growth occurs >48 hours after collection, is isolated to a single blood culture set, or if an alternative diagnosis is more likely.

6.      DO NOT obtain blood cultures for isolated fever, post-procedural fever or isolated leukocytosis. If a patient is hemodynamically stable and develops fever, it is reasonable to monitor and examine for localizing symptoms and signs and use a systematic approach to guide diagnosis and treatment. 

7.      DO NOT obtain blood cultures from indwelling intravenous (IV) catheters. Central venous catheters (CVCs), hemodialysis catheters, tunneled ports and IV catheters, peripherally inserted central catheters (PICCs), midlines, and peripheral IV catheters should not be accessed for blood culture collection given a high rate of luminal colonization.  

8.      DO NOT obtain blood cultures in ambulatory settings. Blood cultures are not indicated for patients with infectious syndromes being treated empirically unless these patients are being hospitalized or directed to the ED.
 
Thank you,
Antimicrobial Stewardship Team
Lab Stewardship Team
Infection Control & Healthcare Epidemiology

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 APP Corner

A person in a white coat holds a vial of blood drawn from a seated person in a brown sweater

Best Practices: The Do's and Do Not's of Blood Cultures

September 4, 2024

Dear colleagues,

Systemwide, ~3000 blood cultures are collected monthly at UTMB.  Approximately 10% of these blood cultures result in microbial growth and ~25-30% are contaminant.

Considering the recent shortage of blood culture media, and non-judicious use of blood cultures, health systems across the country are implementing guidance for judicious use of blood culture collection. Below are best practices:

THE DO’S AND DO NOT’S OF BLOOD CULTURE

1.    DO consider the indication for blood culture collection. Infectious syndromes with a high pre-test probability (>10%) of bloodstream involvement warrant blood culture collection for pathogen identification and antibiotic susceptibility. (Table 1)

2.      DO repeat blood cultures for select bacteremias. Repeating blood cultures is warranted for infective endocarditis, Candidemia, Staphylococcus aureus (MSSA and MRSA) and Staphylococcus lugdunensisbacteremias due to their refractory and metastatic nature. Repeat blood cultures are not indicated in clinically improving patients with most other organisms such as streptococcal or gram-negative bacteremia.

3.      DO reach out to the Infectious Diseases physician on service for guidance on questions or concerns arising from nursing staff or phlebotomy regarding appropriateness of blood cultures collection.

4.      DO escalate “difficult sticks” or patient-related challenges in obtaining cultures to the Charge Nurse or Nursing Educator.

5.      DO NOT automatically repeat blood cultures for coagulase negative Staphylococci (CONS) or other skin commensals. Contamination is suggested when bacterial growth occurs >48 hours after collection, is isolated to a single blood culture set, or if an alternative diagnosis is more likely.

6.      DO NOT obtain blood cultures for isolated fever, post-procedural fever or isolated leukocytosis. If a patient is hemodynamically stable and develops fever, it is reasonable to monitor and examine for localizing symptoms and signs and use a systematic approach to guide diagnosis and treatment. 

7.      DO NOT obtain blood cultures from indwelling intravenous (IV) catheters. Central venous catheters (CVCs), hemodialysis catheters, tunneled ports and IV catheters, peripherally inserted central catheters (PICCs), midlines, and peripheral IV catheters should not be accessed for blood culture collection given a high rate of luminal colonization.  

8.      DO NOT obtain blood cultures in ambulatory settings. Blood cultures are not indicated for patients with infectious syndromes being treated empirically unless these patients are being hospitalized or directed to the ED.
 
Thank you,
Antimicrobial Stewardship Team
Lab Stewardship Team
Infection Control & Healthcare Epidemiology

APP Corner is a monthly feature by, about, and for UTMB's Advanced Practice Professionals.

View Past APP Corner Articles 

'CODING' inside speech bubbles  RCO Coding Clip

A person in a white coat holds a vial of blood drawn from a seated person in a brown sweater

Best Practices: The Do's and Do Not's of Blood Cultures

September 4, 2024

Dear colleagues,

Systemwide, ~3000 blood cultures are collected monthly at UTMB.  Approximately 10% of these blood cultures result in microbial growth and ~25-30% are contaminant.

Considering the recent shortage of blood culture media, and non-judicious use of blood cultures, health systems across the country are implementing guidance for judicious use of blood culture collection. Below are best practices:

THE DO’S AND DO NOT’S OF BLOOD CULTURE

1.    DO consider the indication for blood culture collection. Infectious syndromes with a high pre-test probability (>10%) of bloodstream involvement warrant blood culture collection for pathogen identification and antibiotic susceptibility. (Table 1)

2.      DO repeat blood cultures for select bacteremias. Repeating blood cultures is warranted for infective endocarditis, Candidemia, Staphylococcus aureus (MSSA and MRSA) and Staphylococcus lugdunensisbacteremias due to their refractory and metastatic nature. Repeat blood cultures are not indicated in clinically improving patients with most other organisms such as streptococcal or gram-negative bacteremia.

3.      DO reach out to the Infectious Diseases physician on service for guidance on questions or concerns arising from nursing staff or phlebotomy regarding appropriateness of blood cultures collection.

4.      DO escalate “difficult sticks” or patient-related challenges in obtaining cultures to the Charge Nurse or Nursing Educator.

5.      DO NOT automatically repeat blood cultures for coagulase negative Staphylococci (CONS) or other skin commensals. Contamination is suggested when bacterial growth occurs >48 hours after collection, is isolated to a single blood culture set, or if an alternative diagnosis is more likely.

6.      DO NOT obtain blood cultures for isolated fever, post-procedural fever or isolated leukocytosis. If a patient is hemodynamically stable and develops fever, it is reasonable to monitor and examine for localizing symptoms and signs and use a systematic approach to guide diagnosis and treatment. 

7.      DO NOT obtain blood cultures from indwelling intravenous (IV) catheters. Central venous catheters (CVCs), hemodialysis catheters, tunneled ports and IV catheters, peripherally inserted central catheters (PICCs), midlines, and peripheral IV catheters should not be accessed for blood culture collection given a high rate of luminal colonization.  

8.      DO NOT obtain blood cultures in ambulatory settings. Blood cultures are not indicated for patients with infectious syndromes being treated empirically unless these patients are being hospitalized or directed to the ED.
 
Thank you,
Antimicrobial Stewardship Team
Lab Stewardship Team
Infection Control & Healthcare Epidemiology

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RCO Coding Clip is a monthly feature in the FGP Newsletter, with educational and informational items for providers from our Revenue Cycle Operations Coding Team.

Welcome to UTMB

A person in a white coat holds a vial of blood drawn from a seated person in a brown sweater

Best Practices: The Do's and Do Not's of Blood Cultures

September 4, 2024

Dear colleagues,

Systemwide, ~3000 blood cultures are collected monthly at UTMB.  Approximately 10% of these blood cultures result in microbial growth and ~25-30% are contaminant.

Considering the recent shortage of blood culture media, and non-judicious use of blood cultures, health systems across the country are implementing guidance for judicious use of blood culture collection. Below are best practices:

THE DO’S AND DO NOT’S OF BLOOD CULTURE

1.    DO consider the indication for blood culture collection. Infectious syndromes with a high pre-test probability (>10%) of bloodstream involvement warrant blood culture collection for pathogen identification and antibiotic susceptibility. (Table 1)

2.      DO repeat blood cultures for select bacteremias. Repeating blood cultures is warranted for infective endocarditis, Candidemia, Staphylococcus aureus (MSSA and MRSA) and Staphylococcus lugdunensisbacteremias due to their refractory and metastatic nature. Repeat blood cultures are not indicated in clinically improving patients with most other organisms such as streptococcal or gram-negative bacteremia.

3.      DO reach out to the Infectious Diseases physician on service for guidance on questions or concerns arising from nursing staff or phlebotomy regarding appropriateness of blood cultures collection.

4.      DO escalate “difficult sticks” or patient-related challenges in obtaining cultures to the Charge Nurse or Nursing Educator.

5.      DO NOT automatically repeat blood cultures for coagulase negative Staphylococci (CONS) or other skin commensals. Contamination is suggested when bacterial growth occurs >48 hours after collection, is isolated to a single blood culture set, or if an alternative diagnosis is more likely.

6.      DO NOT obtain blood cultures for isolated fever, post-procedural fever or isolated leukocytosis. If a patient is hemodynamically stable and develops fever, it is reasonable to monitor and examine for localizing symptoms and signs and use a systematic approach to guide diagnosis and treatment. 

7.      DO NOT obtain blood cultures from indwelling intravenous (IV) catheters. Central venous catheters (CVCs), hemodialysis catheters, tunneled ports and IV catheters, peripherally inserted central catheters (PICCs), midlines, and peripheral IV catheters should not be accessed for blood culture collection given a high rate of luminal colonization.  

8.      DO NOT obtain blood cultures in ambulatory settings. Blood cultures are not indicated for patients with infectious syndromes being treated empirically unless these patients are being hospitalized or directed to the ED.
 
Thank you,
Antimicrobial Stewardship Team
Lab Stewardship Team
Infection Control & Healthcare Epidemiology

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A person in a white coat holds a vial of blood drawn from a seated person in a brown sweater

Best Practices: The Do's and Do Not's of Blood Cultures

September 4, 2024

Dear colleagues,

Systemwide, ~3000 blood cultures are collected monthly at UTMB.  Approximately 10% of these blood cultures result in microbial growth and ~25-30% are contaminant.

Considering the recent shortage of blood culture media, and non-judicious use of blood cultures, health systems across the country are implementing guidance for judicious use of blood culture collection. Below are best practices:

THE DO’S AND DO NOT’S OF BLOOD CULTURE

1.    DO consider the indication for blood culture collection. Infectious syndromes with a high pre-test probability (>10%) of bloodstream involvement warrant blood culture collection for pathogen identification and antibiotic susceptibility. (Table 1)

2.      DO repeat blood cultures for select bacteremias. Repeating blood cultures is warranted for infective endocarditis, Candidemia, Staphylococcus aureus (MSSA and MRSA) and Staphylococcus lugdunensisbacteremias due to their refractory and metastatic nature. Repeat blood cultures are not indicated in clinically improving patients with most other organisms such as streptococcal or gram-negative bacteremia.

3.      DO reach out to the Infectious Diseases physician on service for guidance on questions or concerns arising from nursing staff or phlebotomy regarding appropriateness of blood cultures collection.

4.      DO escalate “difficult sticks” or patient-related challenges in obtaining cultures to the Charge Nurse or Nursing Educator.

5.      DO NOT automatically repeat blood cultures for coagulase negative Staphylococci (CONS) or other skin commensals. Contamination is suggested when bacterial growth occurs >48 hours after collection, is isolated to a single blood culture set, or if an alternative diagnosis is more likely.

6.      DO NOT obtain blood cultures for isolated fever, post-procedural fever or isolated leukocytosis. If a patient is hemodynamically stable and develops fever, it is reasonable to monitor and examine for localizing symptoms and signs and use a systematic approach to guide diagnosis and treatment. 

7.      DO NOT obtain blood cultures from indwelling intravenous (IV) catheters. Central venous catheters (CVCs), hemodialysis catheters, tunneled ports and IV catheters, peripherally inserted central catheters (PICCs), midlines, and peripheral IV catheters should not be accessed for blood culture collection given a high rate of luminal colonization.  

8.      DO NOT obtain blood cultures in ambulatory settings. Blood cultures are not indicated for patients with infectious syndromes being treated empirically unless these patients are being hospitalized or directed to the ED.
 
Thank you,
Antimicrobial Stewardship Team
Lab Stewardship Team
Infection Control & Healthcare Epidemiology